Estimation of cognitive impairment in chronic pain patients and characteristics of estimated mild cognitive impairment.

Background: Patients with chronic pain suffer from psychological effects such as anxiety due to the pain itself. Pain can not only impair activities of daily living (ADL) and quality of life (QOL), but also impair cognitive function. Therefore, in this study, we aimed to estimate the cognitive function of chronic pain patients using a deep neural network (DNN) model that has already been implemented in society. We investigated the characteristics of patients presumed to have mild cognitive impairment (MCI) and, at the same time, verified the relationship with the questionnaire commonly used in chronic pain research, which is administered by 43 university affiliated hospitals and medical institutions participating in the chronic pain research group of the Ministry of Health, Labor and Welfare in Japan (assessment batteries). Method: The study included 114 outpatients from a multidisciplinary pain clinic, and we estimated their Mini-Mental State Examination (MMSE) scores based on age and basic blood test data (23 items). Furthermore, we classified the estimated MMSE scores of chronic pain patients into two groups based on a cutoff score of 27, which indicates MCI, and compared the blood data and assessment batteries. Additionally, we used a control group of 252 healthy adults aged 45 years or older who visited a dementia prevention outpatient clinic for comparison with the MMSE scores of chronic pain patients. Result: The MMSE scores in chronic pain patients were below the cutoff for MCI. When classified into two groups based on the estimated MMSE score of 27 points, WBC, RBC, Hb, Hct, PLT, UA, BUN, creatinine, Triglyceride, and γ-GT were significantly higher in the blood data. In the MCI group, PDAS values were significantly lower. Furthermore, only in the non-MCI group, a significant correlation was found between the estimated MMSE value and BPI, PDAS, and Locomo. The estimated MMSE scores were significantly lower in chronic pain patients than in healthy adults (p = 0.04). Conclusion: Patients with chronic pain may exhibit cognitive impairment due to systemic metabolic disturbances. This suggests that chronic pain affects activities of daily living, resulting in systemic metabolic disorders.

Association Between Early Mobilization and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Propensity Score-Matched Study.

BACKGROUND: Early mobilization has been shown to promote functional recovery and prevent complications in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the efficacy of early mobilization in patients with aSAH remains unclear. This study aimed to investigate the association between early mobilization and functional outcomes in patients with aSAH. METHODS: This multicenter retrospective study was conducted in Japan and included patients with aSAH who received physical therapy with or without occupational therapy from April 2014 to March 2019. The primary outcome was the modified Rankin Scale (mRS) score, with a favorable functional outcome defined as an mRS score of 0-2 and an unfavorable outcome with an mRS score of 3-5. Patients initiating walking training within 14 days of aSAH onset were classified into the early mobilization group, whereas those initiating training after 14 days were classified into the delayed mobilization group. Propensity score matching analysis was performed to assess the association between early mobilization and favorable outcomes. RESULTS: A total of 718 patients were screened, and 450 eligible patients were identified. Before matching, 229 patients (50.9%) were in the early mobilization group and 221 (49.1%) were in the delayed mobilization group. After matching, each group consisted of 122 patients, and the early mobilization group exhibited a higher proportion of favorable outcomes than did the delayed mobilization group (81.1% vs. 52.5%, risk difference 28.7%, 95% confidence interval 17.4-39.9, p < 0.001). CONCLUSIONS: This multicenter retrospective study suggests that initiating walking training within 14 days of aSAH onset is associated with favorable outcomes.

Bifidobacterium breve M-16V regulates the autonomic nervous system via the intestinal environment: A double-blind, placebo-controlled study.

We conducted a randomized controlled trial to investigate the potential of Bifidobacterium breve M-16 V to improve mood in humans. In this evaluation, we incorporated the use of near-infrared spectroscopy (NIRS), which has been used to evaluate mood states in studies with small sample sizes. Participants were given B. breve M-16 V (20 billion cells/day) for 6 weeks, and their mood state was assessed before and after ingestion. NIRS data were collected at rest and during a mental arithmetic task (under stress). Intake of B. breve M-16 V decreased the heart rate under stress and increased levels of the GABA-like substance pipecolic acid in stool samples. In addition, B. breve M-16 V improved mood and sleep scores in participants with high anxiety levels. These results suggest that B. breve M-16 V affects the metabolites of the gut microbiota and has the potential to modulate the autonomic nervous system and to improve mood and sleep.

Changes in Prefrontal Cortical Oxygenation During Tilt Table Orthostatic Hypotension in Subarachnoid Haemorrhage Patients.

Cerebral vasospasm and delayed cerebral ischaemia in patients with subarachnoid haemorrhage (SAH) are more likely to occur within the first two weeks of bleeding. Thus, conventional management involves absolute rest for two weeks. Recently, studies have reported on the possibility of early mobilisation after SAH; however, its safety has not been sufficiently evaluated. The present study investigates the relationship between cerebral cortex oxygenation and orthostatic hypotension in SAH patients using near-infrared spectroscopy (NIRS). Four SAH patients were laid supine for 5 min before performing a head-up tilt (HUT) to 30°, 45°, and 60° every 5 min using a tilt table bed. Arterial blood pressure was measured before and immediately after HUT. We evaluated O2Hb levels of the left and right prefrontal cortex (PFC) in 11 of 12 times that could be performed without stopping due to orthostatic hypotension. We analysed O2Hb levels at up to 60 s at 10-s intervals after HUT 60 s before mobilisation. We found that O2Hb levels decreased after the first (30°) HUT, but increased after HUT at 45° and 60°. Over a 60-s period, no statistically significant difference was observed. Arterial blood pressure fell by 6% on average across all the 12 tests. These results reveal that HUT orthostatic arterial hypotension caused an instantaneous decrease in oxygenation, but it returned to the baseline shortly thereafter. It is important to monitor the degree of orthostatic hypotension in patients after SAH. Gradual mobilisation may minimise the decrease in arterial blood pressure and maintain oxygenation of the cerebral cortex.

Motor Imagery and Frontal Head Oxygenation: An fNIRS Study.

Motor imagery (MI) is a manifestation of mental movements, but it cannot be identified visually. Therefore, to a large extent, MI assessment has not yet been established. The present study aimed to investigate whether frontal oxy-Hb changes and cardiac autonomic nervous system activity during MI are associated with the psychometric scale assessment of MI and clarify the utility of each index in MI assessment. Thirty-one healthy men and women were included in this study, and Pocket NIRS Duo was used to assess frontal oxygenated hemoglobin levels during walking MI. Simultaneously, heart rate and sympathetic index (low and high frequency (LF/HF) during MI were evaluated using Chiryou Meijin, a heart rate frequency analyser. In addition, a psychometric scale evaluation was carried out in MC and VAS, and its correlation with oxy-Hb levels, heart rate (HR), and LF/HF was investigated. HRs and LF/HF during MI were significantly increased compared with those at rest. However, oxy-Hb levels during MI were not increased. There was a significant correlation between right oxy-Hb levels and mental chronometry (MC) during MI (r = -0.3, p < 0.05). HR and LF/HF were not correlated with MC. VAS was not correlated with oxy-Hb levels, HR, or LF/HF. The results of this study confirm an association between MI performance and frontal oxy-Hb changes and that brain activity is not necessarily elevated during MI. HR were significantly increased but did not show any association with MC.

Effect of Exercise Therapy on Stress Response Evaluated by IoMT Monitoring System.

The Internet of Medical Things (IoMT) system plays a role in various areas of social activity, including healthcare. Telemetry of cardiovascular function, such as blood pressure and pulse, in daily life is useful in the treatment of cardiovascular disease and stress management. However, until now, brain function monitoring technology has not been installed in the IoMT system.In this study, we used near-infrared spectroscopy (NIRS) installed in the IoMT system to evaluate whether consumers who are not medical experts can measure their own brain function correctly. In addition, the IoMT system was used to assess the long-term effects of physical exercise on physical and mental health.We studied a total of 119 healthy adults recruited from a fitness gym in Koriyama, Japan. After receiving instruction in the usage of the IoMT monitoring system including NIRS, the subjects monitored their physical and mental conditions by themselves when they visited the gym. We evaluated the relations between blood pressure (BP), pulse rate (PR), body weight (BW) and age. In addition, we evaluated the left/right asymmetry of the prefrontal cortex (PFC) at rest and BP. We calculated the laterality index at rest (LIR) for assessment of left/right asymmetry of PFC activity; a positive LIR (>0) indicates right-dominant PFC activity associated with higher stress responses, while a negative LIR (<0) indicates left-dominant PFC activity associated with lower stress responses. We studied 47 out of 119 cases who monitored their physiological conditions before and after physical exercise for 6 months for this study.The results showed that the systolic blood pressure and mean blood pressure (p < 0.05) were significantly reduced after the physical exercise for 6 months; body weight did not change significantly (p > 0.05). In addition, NIRS demonstrated that LIR changed to plus values from minus values after exercise (p < 0.01).These results show that (1) consumers who are not-medical experts can measure their own brain function correctly using NIRS; (2) after long-term physical exercise, systemic blood pressure decreased, associated with modulation of PFC activity (i.e., from right-dominant PFC activity to left-dominant activity), indicating that long-term physical exercises caused relaxation in the brain and the autonomic nervous system.

Initiating Mobilization Is Not Associated with Symptomatic Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Multicenter Case-control Study.

OBJECTIVE: The study aim was to investigate the association between initiating mobilization within 7 days after onset and symptomatic cerebral vasospasm (SCV) in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: This was a retrospective multicenter case-control study in Japan. Patients with a diagnosis of aSAH who underwent physical therapy with/without occupational therapy were included and categorized into 2 groups according to the presence or absence of SCV. Initiating mobilization was defined as sitting on the bed edge (at least once, with/without assist, regardless of duration) within 7 days after aSAH onset. Cox proportional hazards regression analysis was performed to evaluate the association between initiating mobilization within 7 days after onset and SCV. RESULTS: The analysis included 510 patients. Among all included patients, 57 (11.2%) patients had SCV. In the univariate Cox proportional hazards regression analysis, initiating of mobilization was not associated with SCV (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.45-1.32). In the multivariate analysis, only the modified Fisher scale was significantly associated with SCV (HR = 26.23; 95% CI = 1.21-571.0). CONCLUSION: Initiating mobilization within 7 days after aSAH onset was not associated with SCV in patients with aSAH.

Changes in Prefrontal Cortex Asymmetry Due to Standing Load in Stroke Patients Measured by NIRS.

Autonomic disorders such as orthostatic hypotension often become a problem during the early mobilization of poststroke patients. We reported that the prefrontal cortex (PFC) oxyhemoglobin changes at rest are often on the right, and a positive correlation was observed between the left and right activity balance and the change in oxy-Hb. In this study, we focused on the asymmetrical changes associated with the standing load from rest. We assessed the left-right asymmetry of the PFC oxyhemoglobin changes at rest and standing load by calculating the Laterality Index at Rest (LIR) and laterality index during activity (LIA); positive values indicate the right-dominant activity, while negative values indicate left-dominant activity. As for left-right asymmetry LIA, the active dominant PFC was reversed in five patients. It should be noted that in almost all of the 13 cases, the active PFC and the lesion side matched. The detailed mechanism of overactivity up to the prefrontal cortex on the lesion side is unknown, but it may be a recovery mechanism that elicits plasticity in the brain network.

Mechanism and Function of the Catch State in Molluscan Smooth Muscle: A Historical Perspective.

Molluscan smooth muscles exhibit the catch state, in which both tension and resistance to stretch are maintained with very low rates of energy consumption. The catch state is studied mainly on the anterior byssus retractor muscle (ABRM) of a bivalve molluscan animal, Mytilus, which can easily be split into small bundles consisting of parallel fibers. The ABRM contracts actively with an increase in the intracellular free Ca ion concentration, [Ca2+]i, as with all other types of muscle. Meanwhile, the catch state is established after the reduction of [Ca2+]i to the resting level. Despite extensive studies, the mechanism underlying the catch state is not yet fully understood. This article briefly deals with (1) anatomical and ultrastructural aspects of the ABRM, (2) mechanical studies on the transition from the active to the catch state in the isotonic condition, (3) electron microscopic and histochemical studies on the intracellular translocation of Ca ions during the transition from the active to the catch state, and (4) biochemical studies on the catch state, with special reference to a high molecular mass protein, twitchin, which is known to occur in molluscan catch muscles.